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Title

The title should be Male Circumcision, per WP:TITLE and WP:UCN which call for unambiguity, as this article only discusses male circumcision. The current arrangement also violates WP:NPOV, as Misplaced Pages takes a stand everywhere that "circumcision is really male circumcision, and any cutting of female genitals isn't circumcision" in contradiction to reliable sources and giving zero weight to these sources. Circumcision is defined as something done equally to both males and females. Either the title needs to change, or the circumcision of females should also be addressed here. The current organization serves those who encourage the circumcision of males but oppose the procedure on females, but Misplaced Pages should not be used for this advocacy.

• Merriam-Webster dictionary
• Compact Oxford English Dictionary
• Dictionary.com
• WordWeb
• Dictionary.net
• WebMD (note M-W's definition "prepuce": , note WebMD's usage of "prepuce": )
• The American Heritage Dictionary of the English Language: Fourth Edition. 2000.
• Medilexicon (definition of prepuce:
• Encarta

Gender-neutral use in sources (tiny sampling):

• Guttmacher Institute
• PubMed article (one of many),
• OxfordJournals article
• New York Times

Disambiguating usage (i.e., "Male Circumcision") in major national/international mainstream sources:

• World Health Organization (WHO)
• National Institutes of Health (NIH)
• UNAIDS

Other disambiguating usages are extremely common in news sources and official documents, as simple web searches on "male circumcision" reveal.

Example of content that cannot be placed anywhere in Misplaced Pages due to this non-neutral arrangement (exclusion of views through organization of material):

In the context of fieldwork among the Kenuz Nubians, El Guindi has argued for "the significance of the notion of the cultural equivalence of male and female circumcision," and further argues "that this cultural equivalence extends analytically as a structural equivalence: that is, the two gendered rituals play equivalent roles in the transition of male and female children to adulthood."

Blackworm (talk) 20:58, 25 May 2009 (UTC)

Please correct me if I'm wrong, Blackworm, but as far as I can tell your above arguments have been made in previous discussions, some of which I've listed below (extracted from the Talk:Circumcision/Archive guide).

• 34. Why only male circumcision?
• 34. RfC: Is circumcision synonymous with male circumcision?
• 47. Name
• 46. Cherchez la femme (Summary by Avi)
• 40. Requested move (Poll)

Debating the issue for the sake of debating the issue is a waste of everyone's time, so can I instead ask whether there are any new issues that you'd like to discuss? Jakew (talk) 21:38, 25 May 2009 (UTC)

Why are you debating it then? Why not just change it? Do you have any new objections, since all the old ones are weak? Blackworm (talk) 22:01, 25 May 2009 (UTC)

Weak indeed. I whole heartedly support changing this article's name to 'Male circumcision" since that is all it covers. Feel free to actually come up with a valid reason not to change it besides male circumcision is more common that female circumcision. Garycompugeek (talk) 00:22, 26 May 2009 (UTC)

Avi's removal of the tag was apparently done without noticing Gary's comment above (judging by the edit summary). ☺Coppertwig (talk) 01:32, 26 May 2009 (UTC)

Yup, I didn't see that. Thanks for fixing that, Gary. -- Avi (talk) 04:07, 26 May 2009 (UTC)

My objections are the same as those expressed in previous discussions, Blackworm. To quote {{round in circles}} (which, oddly, seems not to be included on this page), "Discussions on this talk page often lead to previous arguments being restated. Please read the recent comments, or look in the archives or FAQ section before contributing. New topics for discussion are always welcome." Jakew (talk) 09:42, 26 May 2009 (UTC)

Um, that would apply to settled arguments, Jake. Blackworm (talk) 09:59, 26 May 2009 (UTC)

Actually, I'll amend that. There isn't quite anything akin to a settled argument in Misplaced Pages -- even conclusions arrived at by consensus may be questioned, and even disputed after a time. I'll note that this issue has not arrived at a consensus -- the requested move you point to found no consensus. My understanding is that in cases like that, the standing form in the article must be given precedence, and the title of the article not changed back and forth in a playing out of the dispute. That is my understanding of the usefulness of the {{POV-title}} flag. It serves to pacify those who dispute the current organization, by at least offering them the dignity of having the existence of the dispute shown to the reader -- who by the way may be helpful in bringing the dispute to a resolution, by fresh ideas, or fresh support for one position over another. The latest round of discussing was harrowing and fostered no consensus. Editors were evidently tired of discussing this, as perhaps you are. The tag is a mark that editors don't agree on the content. It's unfortunate that they don't, but it's not unfortunate that the tag is there to inform readers of that fact. When it was recently removed, I patiently reformulated one position of those supporting the change. I invite you to do the same. That's discussion. If you don't respond, I'm not going to go off and change the article name, because I know you still disagree. We don't have a consensus. That's fine. Let's not hide that fact from the reader. Blackworm (talk) 10:35, 26 May 2009 (UTC)

With regard to this edit summary, in light of this latest requested move discussion, is it really a tenable position that the current title is not disputed? I would say no, therefore based on that, since it is disputed, it is clearly problematic, at least to the extent that disputes over article titles are a problem. Again, the tag isn't there to inform the reader that there is a consensus that the title should be something else; that describes an unstable, forcibly short-lived state where users would simply implement the consensus, change the article title to the consensus, and remove the tag. This discussion focuses on the article title, but the editwarring of the tag is merely an insult to those disputing the title -- denying the dignity I refer to above by denying that a dispute even exists. Blackworm (talk) 10:48, 26 May 2009 (UTC)

Blackworm, the tag was originally added on the 19th of June, 2008, and at the time it served to draw attention to the requested move that was then active. But when that discussion closed with "no consensus to change the title" (to quote from an AN/I discussion about a similar situation), the tag had served its purpose. To quote again from that AN/I discussion: 'The tags aren't meant to stay in place once the debate is resolved, and "no consensus" is considered a resolution.'

Despite the closing of the requested move on 28th June 2008, the tag has been present for approximately another eleven months. There comes a point when one has to conclude that a tag has been present for long enough, and if it was going to produce any valuable new input then that would have already happened. Also, tags are not intended to give editors "dignity" (edits should always be made for the benefit of the article), but even so, how much more dignity do you want? Is eleven months not enough? As with all 'disputed' tags, the {{POV-title}} tag is not intended to be a permanent addition, nor is it a kind of 'banner' to demonstrate dissatisfaction.

By analogy, I've participated in numerous deletion debates. There are plenty of articles that, in my view, should have been deleted, but there was no consensus to do so. Assuming such a template even exists, it wouldn't be appropriate for me to tag those articles with something like "it is disputed whether this article should exist", because that proposal has been made, we couldn't get consensus, and that's it. Yes, in some cases I'm not happy about that, and feel that policy is being ignored, but that doesn't mean that there is an active dispute that needs to be brought to the reader's attention.

I'm afraid I don't intend to present the same arguments again for the sole purpose of being able to say that we're having a discussion, in turn for the sole purpose of justifying the existence of the tag. That seems — words fail me here — completely backwards. Jakew (talk) 12:14, 26 May 2009 (UTC)

That isn't the purpose, Jake. The purpose is to build the best encyclopedia possible. I was attempting to explain my understanding of the purpose of tagging; I'm sorry if my explanation was of no use to you. I don't share your apparent pessimism regarding new input, new ideas, or the possibility of reaching a consensus. I didn't say that tags were intended to provide dignity -- I merely observed that they do, as they reduce to zero the desire of calm, rational editors to editwar the content in the absence of a consensus. Your statement, "There are plenty of articles that, in my view, should have been deleted, but there was no consensus to do so" seems likely incomplete; in order for your analogy to apply, there would have to be no consensus to keep the article either, and the AfD result marked as "no consensus." Was this the case in "plenty of articles" as you state? Even if so, what would be the relevance? You decided to abandon the dispute despite no consensus for or against? Perhaps enviable, perhaps not. Weren't you convinced that a consensus would develop, given more input, at perhaps a later time? I would argue that in those cases a tag on the article would indeed be appropriate, especially if you and others disputed the existence of the article on WP:NPOV grounds, one of Misplaced Pages's core policies.

You also again raise the again recently heard fallacy, through your choice of analogy (noting, e.g., only your view, not whether there was other support), that support for this title change, or a change to the content, is an example of one editor's fringe position. It is not, as the discussion showed, and I'm tired of arguing the contrary in the face of that evidence.

I agree that tags are intended to be temporary, although by "temporary" I read that to mean "until a consensus is reached." If a move request discussion found no consensus to move nor not to move, then there is no resolution. One should not oppose consensus, but here there to no consensus to oppose. If you can point to where in Misplaced Pages policy it says that "'no consensus' is considered a resolution" I'd be quite obliged. It seems merely the expressed opinion of yourself and another editor. On the contrary, many editors appear to contribute to the essay WP:NPOV_dispute, which states, Sometimes people have edit wars over the NPOV dispute tag, or have an extended debate about whether there is a NPOV dispute or not. In general, if you find yourself having an ongoing dispute about whether a dispute exists, there's a good chance one does, and you should therefore leave the NPOV tag up until there is a consensus that it should be removed. However, repeatedly adding the tag is not to be used as a means of bypassing consensus or dispute resolution. If your sole contribution to an article is to repeatedly add or remove the tag, chances are high that you are abusing your "right" to use the tag. Therefore Jakew, I invite you to help find a consensus, or follow dispute resolution. Blackworm (talk) 20:22, 26 May 2009 (UTC)

Yes, Blackworm, I'm referring to discussions closed as "no consensus". That's how Misplaced Pages works: someone proposes a change, people discuss it, and either there is a consensus to make the change or there isn't. If a "new consensus" fails to develop then we fall back on the assumed "previous consensus", ie. the status quo (I have grumbled about this in the past). Sometimes you feel that the outcome was a mistake. In such situations, you have essentially three options. The first is to wait and try again if/when that would not be disruptive. The second is to propose an alternative change, one that might gain consensus. The last is, I'm afraid, to put up with it. Tagging articles as a semi-permanent mark of disapproval is not really a valid option. Jakew (talk) 09:47, 27 May 2009 (UTC)

Which AfD's were you involved in that were so closed? Can you provide a few links, since you say there were "plenty?" No, there are at least three possible outcomes to an AfD, including "keep," "delete," and "no consensus", each with different implications. (See WP:AfD Same goes for requested moves. Also, this dispute isn't only about a requested move; that was only one possible solution. Another would be to properly treat circumcision as inclusive of everyone circumcised, not just males. You're referring to what the disputed content should say during and after the dispute when no consensus is found to change it or keep it. Indeed no one has recently changed the title of this article, or added female circumcision content, in accordance with that. You, however, are arguing that the neutrality tag be removed in the absence of a consensus to remove it. That is not in accordance with policy, but in opposition to policy. Also, you make clear that one option is to wait and try again. Eleven months have passed, with no apparent consensus (other than to have the tag on the article!). Many changes have been proposed, but they are opposed on apparently misinformed, activist grounds (as the RM discussion showed -- calls of "neologism" contradicted by sources, etc). Perhaps that activism is how articles are meant to be organized, but I don't get that impression from reading policy. There's no problem with a fresh round of discussion, since no consensus one way or the other came out of the last several rounds, especially if we can get past certain IMO non-Wikipedian opinions that those opposing the current non-neutral content and organization should "put up with it" and have the article appear as if the consensus is against them, despite there being no consensus against them. Blackworm (talk) 20:07, 27 May 2009 (UTC)

Here is one example. I'm afraid that going through my contributions to find other AfD discussions closed as "no consensus" would be time consuming and somewhat pointless. However, you're welcome to do so, if you want. Jakew (talk) 20:41, 27 May 2009 (UTC)

No, that example serves my point well -- note the existence of a "defacing" tag (a word used by User:Jayjg to describe NPOV tags on circumcision, who also happened to support your position in that AfD) on that article -- a tag that has been there for almost two years, with no active discussion. QED. Blackworm (talk) 21:03, 27 May 2009 (UTC)

There is no limit to the amount of times a dispute may be revisited. I would have reopened up another change request and added an RFC to it but was hoping that someone else would this time round. This needs to be cleared up because it causes problems in both circumcision gender articles. Female genital cutting is completely biased and tries to distance itself from circumcision by not mentioning circumcision in the title and male circumcision does not want anyone to think about horrible female circumcision or hey you might think unfavorably on male circumcision. Its all a load of bullshit. Garycompugeek (talk) 20:29, 26 May 2009 (UTC)

The tag on the article Circumcision advocacy was about something that could be fixed (in my opinion). If it had no reasonable chance of being fixed, then I don't think the tag should have stayed. The point still remains that articles that have survived AfD don't generally have tags on the face of the article stating that some editors would like to delete the article. That wouldn't look nice and wouldn't be very useful. I think it's similar here: different editors have different points of view about the meanings of the terms "circumcision" and "male circumcision", and we're not here to change each others' points of view. It may be that there will never be complete agreement on the name. There could be a situation where different editors would insist on tags regardless of which of two (or more) names for an article were used. But tags are supposed to be temporary.

I have another idea: rather than a tag on the face of the article, I suggest a tag at the top of the talk page, describing the situation with the page naming dispute. ☺Coppertwig (talk) 01:52, 31 May 2009 (UTC)

Coppertwig, you write, "There could be a situation where different editors would insist on tags regardless of which of two (or more) names for an article were used. But tags are supposed to be temporary." You've summarized well the position of editors opposing the tag that "no consensus" implies that we must present the article to the reader as if there is a consensus. You've based your argument, as elsewhere with your change of heart at the time of the Requested Move discussion, on the possible actions of editors in the future. Again, I'm not swayed by that line of argument. Note also that NPOV policy states, When any dispute arises as to what the article should say, or what is true, we must not adopt an adversarial stance; we must do our best to step back and ask ourselves, "How can this dispute be fairly characterized?" This has to be asked repeatedly as each new controversial point is stated. It is not our job to edit Misplaced Pages so that it reflects our own idiosyncratic views and then defend those edits against all-comers; it is our job to work together, mainly adding or improving content, but also, when necessary, coming to a compromise about how a controversy should be described, so that it is fair to all sides. Consensus is not always possible, but it should be your goal. Is it your goal? Or are you and Jakew advocating the opposite: a silencing of opposing views based on whatever state the article happens to be in at the latest iteration of the dispute? It seems to me to be the latter. Blackworm (talk) 16:14, 3 June 2009 (UTC)

I just created Talk:Circumcision/FAQ, which I suggest can summarize arguments on all sides of longstanding disputes on this page such as this one. I further suggest that the arguments in the FAQ be written only by people on the opposite (or some other) side of the dispute. There are several possible benefits to doing it that way: By writing the opposing side's arguments, one can learn to understand those arguments better, and possibly feel more sympathetic towards them. Misunderstandings or lack of understanding can also come to light. And seeing the person on the opposite side write the arguments can lead to better feelings: since one can see that the person understands the arguments yet still continues to disagree, one might feel less need to repeat oneself and possibly more respect for the other person's position. One disadvantage of doing it that way is that people usually aren't very good at writing arguments they disagree with. It may take a number of iterations, with people explaining on this page what's missing, before a satisfactory version is developed. During that process, I think it's important to assume good faith: if someone writes a very poor explanation of an argument, it may really be the best they're able to do, because it isn't easy to write arguments one disagrees with. Rather than accusing the person of not trying, it's better to thank them for trying and gently explain to them what's missing. This suggestion is based on a suggestion by Abd here (about three-fifths of the way down).

In reply to Blackworm: consensus is my goal. I assume it's also your goal to find a consensus which includes my view that articles look better without tags. When it says to describe the controversy, I think it means to describe it in paragraph form (and perhaps with choice of article titles and hatnotes), not to describe it via tags. ☺Coppertwig (talk) 00:50, 6 June 2009 (UTC)

I think Blackworm has made a good enough case for changing the title to male circumcision. Maybe Jakew or someone else can go over the arguments for retaining the clearly ambiguous current title? I seem to remember a google count on the different terms. This is not always adequate or appropriate as a I believe is said in the guidelines. Presumably this guideline is so that people can find what they are looking for. This wouldn't be a problem as it would be re-directed. Accuracy, being specific, and not creating ambiguity, is more important than this anyway.

"Circumcision" could be re-directed to "male circumcision". The article would start with: Male circumcision, more commonly known as just circumcision... Something could also be added about the distinction between male and female circumcision.

Let's be clear - both (male and female) are circumcisions - is anyone actually disagreeing with this statement? Sorry, I don't know why there is resistance.

Jakew may I also remind you that you vetoed the term "routine infant circumcision" on the basis that not everyone used the term - isn't that a bit hypocritical? If we are going by the most commonly used term to describe something then why don't we use 'routine infant circumcision'? Tremello22 (talk) 14:08, 9 June 2009 (UTC)

The arguments against renaming as "male circumcision" have been explained previously, Tremello. Please see the links I provided in my post dated 21:38, 25 May 2009 — I would recommend starting with the Poll or with Avi's summary.

Your argument for renaming the article as "routine infant circumcision" is bizarre. Checking Google indicates that the term "circumcision" is used about 53x as often as "routine infant circumcision" (4,100,000 vs 77,600), so I do not understand why you think the latter is "the most commonly used term to describe something". Moreover, the term "routine infant circumcision" is rarely used to describe religious circumcision of infants, and never used to describe circumcision of older males, so it would be an inappropriate title for this article, which includes both. Finally, you appear to misunderstand why I argued that we should avoid the term. My argument was not that "not everyone used the term", but was instead that the meaning of the term is unclear, and if used in the way you proposed it would seem to contradict one of the few definitions given in reliable sources. Jakew (talk) 14:33, 9 June 2009 (UTC)

Jakew I am not proposing we title the article 'routine infant circumcision', I was referring to the previous debate above over the title of the non-religious circumcision in the English speaking world section. That section is primarily about RIC and it is the most common term used to describe that type of circumcision.

You say this term is unclear - this is the same thing Blackworm, Gary and I are saying - circumcision on its own is ambiguous because - there is also female circumcision. Yes circumcision may be used more often to refer to male circumcision but so what? The fact is they are both circumcisions - let us remove the ambiguity. Tremello22 (talk) 15:08, 9 June 2009 (UTC)

Outside of "intactivist" circles, the word "circumcision" by itself unambiguously refers to circumcision of the penis. If anything, "male circumcision" is a back-formation based on the poorly-named FGC or FGM practice, up to and including clitoridectomy, which is not, in fact "circumcision". As has been pointed out previously, calling alteration of female genitalia "circumcision" is exactly mislabeling. That this mislabeling is prevalent in the literature is irrelevant, since that mislabeling is always as "female circumcision", not simply "circumcision", which in such literature only uses "male circumcision" to clarify the matter _in that literature_. WP:NC would support moving this article to Male circumcision only if this were genitowiki or whatever one would call a wikiresource dedicated to genitalia... Tomer 07:31, 10 June 2009 (UTC)

Absolutely and totally wrong, as evidenced by the sources presented above, and in the previously discussions. It is very difficult to debate an issue when one side refuses to acknowledge what the sources show, and instead chooses to provide handwaving and personal opinion, and repeat claims shown by these sources to be unsubstantiated. No one can controvert the sourced evidence presented, and so one must wonder why, barring the influence of fringe male circumcision advocates and fanatical female circumcision opponents wishing to change the language, this article does not conform to or indeed even acknowledge the sense of the word as presented in all major dictionaries, in many scholarly articles and in international literature on the subject. Circumcision is done to both males and females. Want proof? Look up "circumcision" in a dictionary. How opponents of this obvious state of reality can continue to argue and debate and want to stuff this whole issue into a useless "FAQ" completely eludes me. Blackworm (talk) 12:01, 10 June 2009 (UTC)

Expound. Male and Female circumcision goes back over a thousand years. The time and place plays a huge factor in prevalence. Garycompugeek (talk) 15:22, 10 June 2009 (UTC)

Tomer, maybe you should state where you are getting the definition of 'circumcise' from. You don't seem to provide any sources (like Blackworm has) - just your own (seemingly biased) opinion.

That this mislabeling is prevalent in the literature is irrelevant, since that mislabeling is always as "female circumcision", not simply "circumcision", which in such literature only uses "male circumcision" to clarify the matter _in that literature_ Nobody doubts there has been a move by the Western press to describe what happens to females as FGM or FGC. Nobody is denying that 'circumcision' is more often used than 'male circumcision' to refer to 'male circumcision'. The reason, in some sources, they use the term 'female circumcision' (and mislabel as you seem to think) is because in the West, male circumcision is more common, and female circumcision is largely unheard of. So it makes sense that people who only really know of male circumcision would associate the word 'circumcision' with males. The articles you mention use the term 'female circumcision' to let the reader differentiate between male and female circumcision.

calling alteration of female genitalia "circumcision" is exactly mislabeling You only say this because you are comparing male circumcision to female circumcision and coming to the conclusion they are not equal in severity and so you feel a great need to give one a more extreme name than the other. But as Gary says 'Male and Female circumcision goes back over a thousand years.' Presumably the terms go back thousands of years too, no? Female circumcision is practiced in cultures totally different to our own. In the non-Western Muslim world they would be more likely to describe a circumcision on females as a female circumcision as opposed to a female genital mutilation or a female genital cutting. Because the term circumcision can encompass both female and male circumcisions - it should be changed to male circumcision. You bring up the naming conventions guideline - like Jakew often does, you pointed to a guideline without specifying how it actually applies in the given situation. From WP:NC, Misplaced Pages:NC#Be_precise_when_necessary seems to apply. The very fact that we need to put a disclaimer: This article is about male circumcision. For female circumcision, see Female genital cutting. shows you that many people still, like it or not ,would describe what happens to females as circumcision. So, why not be precise? Tremello22 (talk) 23:00, 10 June 2009 (UTC)

I alternately suggest this title, if "Male Circumcision" (as used by the WHO, cited often here as an authority on the subject, eclipsing other views, such as that on prevalence) isn't "common" enough for some, as the argument seems to go: "Circumcision (male)." The hatnote can say Circumcision redirects here. Female circumcision is covered in Female Genital Cutting. It still looks bad, as the reader must wonder, why is male genital cutting not called Male Genital Cutting? I'd say ask the WHO. But yes, we must reflect the sources. Let's do that. Blackworm (talk) 06:04, 11 June 2009 (UTC)

I think that "Circumcision (male)" is somewhat better than your previous suggestion ("Male circumcision"), but most of the objections raised in previous discussions still apply. I'd also point out that "Circumcision (male)" is incompatible with your apparent goal, that is, to remove all ambiguity. One can sometimes (albeit very rarely) speak of circumcising the areola, so "Circumcision (penile)" would be more precise. But this, of course, assumes that the goal is to have no ambiguity, rather than the "reasonable minimum of ambiguity" specified by WP:TITLE#Use the most easily recognized name, etc. Jakew (talk) 08:18, 11 June 2009 (UTC)

From, reading Avi's summary it seems to me that you are saying that because the term 'circumcision' is used more often to refer to male circumcision than 'male circumcision' , we are justified in not being precise (to an appropriate degree). I completely disagree. As the guideline I pointed to above says "Be precise when necessary". I think this guideline is the one we should be using. It is not as if, if we call it 'male circumcision' , less people will find the article about the circumcision of males. Especially if 'circumcision' is re-directed to 'male circumcision' (on the reasoning that circumcision is more often used to refer to circumcision on males).

The reasoning behind the naming guidelines is to make it easier for people to find the article they were looking for. If they are looking for specifically male circumcision - then the article they end up reading should be named accurately, without any ambiguity. I read that poll above, and my honest interpretation is that some of the reasoning behind those who opposed the change is down to the fact that they don't want to equate female circumcision with male circumcision. In other words they let their emotions get in the way of thinking logically.

I think people have not 'got' what the goal of editing should be. We shouldn't be trying to make this the most popular circumcision page on the web - we should be making it the most informative and accurate. I think Jakew you are worrying about making this wikipedia article the number one hit on google. You have assumed ownership of the article, guarded it, and steered it to concentrate on the medical aspects (even though 2/3 of circs are Muslim and not done for medical benefits). I wonder why? Presumably the purpose of this is to play on the human instinct, better be safe than sorry - lets circumcise.

I think we need to re-assess what information this article is trying to put across. If we are to agree with the above - that the goal is to create an informative, non-biased article that reflects the worldwide view - and not to regard these goals as secondary to the goal of making it most popular/viewed, then we should change it to 'male circumcision'. If you agree with this 'google hits' are irrelevant. Tremello22 (talk) 20:26, 11 June 2009 (UTC)

Note that there exists a WP:Disambiguation guideline. I quote from it: "Disambiguation is required whenever, for a given word or phrase on which a reader might use the "Go button", there is more than one Misplaced Pages article to which that word or phrase might be expected to lead." Is there for circumcision? For a given reader, I argue there may indeed be: the article on male circumcision, and the article on female circumcision, since the two topics are currently wholly separated as if unrelated. There is no article in Misplaced Pages on the topic of "circumcision" in the dictionary sense of "1. to cut off the foreskin of (a male) or the prepuce of (a female)." Note, M-W's definition has recently changed. Some readers may expect one article, but one article where the topic of circumcision to be treated gender-inclusively, as general usage indicated by dictionaries seems to validate. But that goes beyond the scope of mere reasonable minimization of ambiguity -- called for by Misplaced Pages:Naming_conventions policy. It's that reasonable minimum of ambiguity I believe is amply demonstrated by the sources I've brought. I'm quite confident that many would agree so far, whether they agree or not with my questioning whether opposition to the change stems from a desire to enforce one POV overwhelmingly over another, or possible conflicts of interest or outside interests. I again call for a the title to be changed to "Male Circumcision" or "Circumcision (male)," with a redirect from circumcision to male circumcision (rather than the odd reverse, as is currently the case).

I also recommend the Misplaced Pages:Naming_conflict guideline, which the Misplaced Pages:Naming_conventions policy says "may help resolve disagreements over the right name to use." The former says, "A naming conflict can arise on Misplaced Pages when contributors have difficulty agreeing on what to call a topic or a geopolitical/ethnic entity. These sometimes arise out of a misunderstanding of the Neutral Point of View (NPOV) policy." "A name used by one entity may well clash with a name used by another entity. Disambiguation and expansion can resolve overlapping names. These overlapping meanings can be resolved by proper disambiguation." Under the suggested procedure for resolving disputes, under "descriptive names" as is the case here, it says, "Where articles have descriptive names, the given name must be neutrally worded and must not carry POV implications. A descriptive article title should describe the subject without passing judgment, implicitly or explicitly, on the subject." "We cannot declare what a name should be, only what it is." We are declaring that the name for male circumcision is circumcision. We are also declaring that the name for female circumcision is not circumcision, in fact it's a phrase that does not contain the word "circumcision." Is this a problem? Should it be addressed? The ones supporting a change back to male circumcision say yes, and the ones opposing the change say no. The ones supporting a change say that combination of these two facts, about two articles, one on the circumcision of males, another on the circumcision of females, may be an NPOV problem -- do the ones opposing the change say it would create an NPOV problem to change it? They don't; they simply dismiss the prevalent idea that an NPOV problem exists currently and state that therefore no reason exists to change it. It isn't a compelling counter-argument, in my opinion. The guideline concludes, "In the end, if all else fails, just leave the article at its original name." It's difficult to see what that is, oddly, as this first "diff" refers to "moving" the text into a new article, though there is no N next to the edit, and the diff shows a previous version with a date a year later than the edit. Is it a glitch caused by administrative oversight (i.e. a memory hole), or a technical failure? In any case, if the first article talking about circumcision in Misplaced Pages was created as "Circumcision," and not anything else, that indeed would be the first potentially valid argument I've heard for leaving the title "circumcision" if all other attempts to resolve the dispute have been attempted in good faith and failed. But has all else failed? Has disambiguation failed? If so, how has disambiguation been attempted in the effort to resolve the dispute?

Finally, note that Neutral Point of View policy says, "If a genuine naming controversy exists, and is relevant to the subject matter of the article, the controversy should be covered in the article text and substantiated with reliable sources." Perhaps a naming controversy does exist, and this should be covered in the article text (not a hatnote that implies an unrelated topic). I think doing that is called for, as soon as possible, and it might even satisfy NPOV, especially in light of the recent changes that appear to have consensus, such as beginning the article text "Male circumcision is..." Blackworm (talk) 04:27, 17 July 2009 (UTC)

Blackworm asks, "how has disambiguation been attempted in the effort to resolve the dispute?"

To quote WP:DAB, with highlighting added to show the form of disambiguation used in this article:

Two methods of disambiguating are discussed here:

• disambiguation links – at the top of an article (hatnotes), that refer the reader to other Misplaced Pages articles with similar titles or concepts.
• disambiguation pages – non-article pages that refer readers to other Misplaced Pages articles.

(Please note that I do not intend to state or imply in any way that disambiguation has failed. My purpose in mentioning it here is simply to show that this form of disambiguation is, in fact, used in the article.) Jakew (talk) 08:30, 17 July 2009 (UTC)

Was there a reason nobody responded to my last comment? It is quite funny that the topic has turned to disambiguation hatnotes. Why not remove the ambiguity and just call it male circumcision? I don't think anybody has come up with a valid reason to oppose this change. I thought the aim of wikipedia was to produce accurate articles, not for editors to make their article the most viewed as a kind of ego-stroking exercise. Tremello22 (talk) 20:57, 18 July 2009 (UTC)

In reply to Jakew, the hatnote hasn't changed since the dispute started, thus disambiguation has not been attempted in the effort to resolve the dispute. Thus you've made irrelevant, misleading comment #348. Let's go for 350 by the end of the day. Blackworm (talk) 23:23, 23 July 2009 (UTC)

An amusingly legalistic response, Blackworm, and even more amusing since it is wrong. The hatnote was added at 01:10, June 13, 2006; the talk page at the time included apparent debates re the title and/or scope such as this and this. Jakew (talk) 08:50, 24 July 2009 (UTC)

Reasons for non-therapuetic neonatal circumcision (primarily in the USA)

Studies of this type:

http://pediatrics.aappublications.org/cgi/content/abstract/80/2/215

http://www.cirp.org/library/legal/USA/waldeck1/

which explain the reasons behind the decision would be a welcome addition to the article in my opinion. Ideally if there was a section devoted specifically to routine infant circumcision as it is most commonly called, then it would obviously go there. Without a section such as that (the title is of secondary importance) then I'm not sure where it would go. Tremello22 (talk) 17:50, 23 June 2009 (UTC)

COI tag

Recently someone has placed a COI tag on the article talk page. I agree the edit summary was tactless but do agree with the tags placement. There have been discussions about Jake on mine and his talk page about a possible COI. Currently this matter is being taken up at Misplaced Pages:Conflict of interest/Noticeboard#Circumcision and Misplaced Pages:Administrators' noticeboard/Incidents#Request review of administrative action. Garycompugeek (talk) 18:40, 8 July 2009 (UTC)

Note that a completely uninvolved user agrees that there is no COI here and the POV <> COI. I've unprotected the pager as discussed on WP:ANI but reserve the right to re-protect should continued BLP violations or disruptive editing exist. Thank you all for your patience. -- Avi (talk) 05:34, 10 July 2009 (UTC)

I will not edit war over the COI tag Avi (never did in the first place) but was only lending my support to it's initial placement. I will not press the COI issue as long as neutrality is adhered to. Most of the admins at ANI do feel that placing a COI tag is not a BLP violation, indeed you could argue that anytime if it was true and we wouldn't need the tag. If you need further clarity in the matter we could gain it on the BLP talk page. Garycompugeek (talk) 13:03, 10 July 2009 (UTC)

Jake has had to endure many days of discussion on this. The uninvolved editors who commented specifically about COI at the ANI and COIN threads were unanimous that there was no COI. Just to forestall any further discussion, I'd like to point out that WP:COI says "Using COI allegations to harass an editor or to gain the upper hand in a content dispute is prohibited, and can result in a block or ban." Now that these noticeboard discussions have been closed: (in my opinion, for what it's worth as that of an involved editor) further mentioning of or alluding to alleged COI on Jake's part without what would be considered by typical uninvolved Wikipedians as good reasons could be considered disruptive. (Thread was re-opened.) ☺Coppertwig (talk) 23:54, 15 July 2009 (UTC)

Totally disagree with your assessment of what constitutes "disruptive" comments. Editors are entitled to express their opinions on interpretations of policy or guideline. The role of uninvolved editors isn't to notice that a discussion has been "closed" because one uninvolved editor has expressed a view on it and put a Resolved tag on it, and then accuse any editors for which the issue is not resolved of disruption, as you imply. It is to participate in the discussion and help a consensus develop. The legalistic attempts to stifle discussion, always with threats, are far from Wikipedian, one might go so far as to say they are non-Wikipedian. I'll note that the uninvolved editor in question appears to agree that if the issue is being debated with no clear consensus, it cannot be considered closed. The editor removed the Resolved tag. Discussion is welcome at Misplaced Pages:Conflict of interest/Noticeboard#Circumcision. Blackworm (talk) 02:22, 16 July 2009 (UTC)

You may disagree all you wish, Blackworm. A completely uninvolved editor agreed with what we believe is the straight and simple understanding of the policies, and patiently tried to explain it to you. Also, I'm gratified to see that uninvolved people understand the use of terms such as "projection" in the context of a discussion, and don't immediately and incorrectly claim "personal attacks" where none exist. This is not the first or second time you try and misstate what I say as some kind of personal attack. Perhaps it is a defense mechanism to obviate the need for you to respond; attacking the messenger as opposed to the message is a known debating technique - it is the fallacy of argumentum ad hominem. Thankfully, the uninvolved editor in this case saw beyond your claim. And yes, Blackworm, at times it appears to me that you are choosing not to understand; you are choosing to focus on semantical wording instead of content and context. I am not the only one. Atama said to you as well: "You're quoting part of the lead of WP:COI and taking it out of context." So, once again, claiming "personal attack" falls flat. Part of engaging in discussion, Blackworm, is having your statements and your motives critiqued. It is certainly more a "personal attack" to try and paint Jake as someone who lacks integrity and cannot edit wikipedia due to some financial or similar gain, than it is to point out the weaknesses in your arguments, or your denial of what seems to be clear to most others. Again, as I've said many times, if you think I am in violation of wikipedia policies, you are well within your rights to file an RfC. However, one of the beauties of wikipedia is that most anything anyone has ever said is available, and our respective records are open for anyone and everyone to investigate. -- Avi (talk) 03:55, 16 July 2009 (UTC)

No, Atama did not say I was "choosing" not to understand, which is a accusation of bad faith and a personal attack. You're free to RfC that -- let's see if others agree that I'm "choosing not to understand." If pointing out one's external interests (in Jakew's case, increasing the visibility of material mostly presenting circumcision favourably and vice-versa) and their conflict with the values of Misplaced Pages is a personal attack, then COI investigations are personal attacks. Atama apparently disagrees with my reading of COI as applying to outside interests appearing to take precedence over Misplaced Pages's interests, and the resulting danger for propagandistic editing, not necessarily only financial gain or promotion of services. If it is indeed "clear to most others" that will come out of the discussion, but it is quite far from being the case. Again, maybe some dont' mind that Jakew founds organizations to counter what he considers deceptive anti-circumcision groups, by publishing a collection of authoritative material which disproportionately presents male circumcision favourably, and then comes to Misplaced Pages and dominates all circumcision-related articles with the enthusiastic approval of yourself and User:Jayjg for years, turning them into an article disproportionately reflecting one point of view. Then again, some do mind. It appears to go against Misplaced Pages's values, and the longstanding WP:NPOV failures of those articles is the result. Blackworm (talk) 11:45, 16 July 2009 (UTC)

Until the COI is closed would it not be prudent to place the tag back on the article to attract people to the debate and weigh in? Garycompugeek (talk) 18:50, 17 July 2009 (UTC)

Absolutely not. We understand there are POV issues, thus the POV tag. However, outside of yourself and Blackworm, both of whom are decidedly not neutral in this regard, everyone else who has commented believes that there is no COI. It should be noted that improper tagging of articles has been viewedin the past as disruptive and pointed editing. -- Avi (talk) 19:00, 17 July 2009 (UTC)

I am as neutral as you Avi. I do not fear outside opinions. Why do you? (everyone else = one uninvolved editor commented) Garycompugeek (talk) 19:15, 17 July 2009 (UTC)

"One uninvolved editor"? I fear you've miscounted. I count two uninvolved editors (SlimVirgin and Atama). (As an aside, could someone please refactor the chaotic indentation in this section? It's very hard to follow.) Jakew (talk) 19:36, 17 July 2009 (UTC)

I stand corrected. Perhaps SlimVirgin will be kind enough to join us on the COI page and discuss her view. I shall invite her. Garycompugeek (talk) 20:29, 17 July 2009 (UTC)

"History" and "Cultures and religions" sections

The history and cultures and religions sections have been tagged for some time with {{sync}}. In my view these tags are unnecessary, and I therefore propose to remove them. Does anyone object? Jakew (talk) 15:51, 14 July 2009 (UTC)

Why do you deem them unnecessary? Presumably there was a reason they were put there. I think the idea is to include more of the social history of circumcision and not concentrate so much on medical studies into the effect of circumcision. I think your conflict of interest is stopping you from seeing this imbalance. Tremello22 (talk) 20:41, 18 July 2009 (UTC)

"Unnecessary" was perhaps a poor choice of word. The tags read "The following text needs to be harmonized with text in History of male circumcision", but it is not clear what disharmony is perceived to exist. In this respect, they are unnecessary, because they have no function: they don't identify the problem that they are intended to highlight. And if we don't know what problem they highlight, then how are we supposed to know if/when it has been solved?

Given the text of the tag, your suggested explanation seems unlikely. Even if the editor who added them shared your view about the ideal lengths of the respective sections, the tags would fail to express that viewpoint. Jakew (talk) 21:34, 18 July 2009 (UTC)

Tremello, I'm sorry that I don't quite understand what you said: are you guessing why someone wants the tag there, or do you yourself agree with the message of the tag? Unless someone who thinks the article needs to be changed explains here on the talk page what changes are needed, I think the tag can be deleted. ☺Coppertwig (talk) 11:45, 19 July 2009 (UTC)

I agree with the message of the tag. I think we should restore some of my additions above that were discussed here: Talk:Circumcision#Structure_of_article This is what is meant by synchronize/harmonize. Important information has been left out of this article which would give the reader a better idea of the social history of non-religious circumcision. Also see what I wrote here: Talk:Religious_male_circumcision#Requested_move Tremello22 (talk) 13:05, 21 July 2009 (UTC)

Tremello, the purpose of a {{sync}} tag is to highlight specific work that is needed to harmonize content between a summary and a detailed article. That is, for it to be needed there must be some disharmony between the two. That is not the same thing as merely wanting to make some changed that failed to achieve consensus. I also think that you're projecting your intentions for the article onto whoever added the tag; certainly you haven't provided any evidence to support your assertion that this is what was meant by the tag. Jakew (talk) 13:19, 21 July 2009 (UTC)

It is fairly obvious what is meant by the tag Jake. It means that chunks of information have been left out of the main article causing an incomplete picture and gaps in the narrative of the article. As for my additions above, a voting system is generally discouraged at Misplaced Pages because things are often rejected for the wrong reasons. I have now had a new idea. We should get rid of history of male circumcision . Just like religious male circumcision, Non-religious circumcision in the English-speaking world should be span out into a new article from the main page. This article should then have a short summary of African/Tribal circumcision and that should be given its own detailed article too. I think that is the best solution. That way people can easily find what they want. Tremello22 (talk) 13:56, 21 July 2009 (UTC)

Personally I think the idea is ill-considered, but you are of course free to nominate history of male circumcision for deletion (see WP:AfD for details). In any event, it is a separate matter from the {{sync}} tags. Jakew (talk) 14:56, 21 July 2009 (UTC)

Latest edit

In the edit summary for this I fail to mention that I removed the part about "bodily integrity" (as UNICEF discusses in the context of circumcision of females) and sexual discrimination (as some opponents indeed state, if I remember the sources correctly), because:

• (a) the circumcision article currently has an inappropriately narrow scope, with reliable sources making reference to female circumcision alternately labeled "not at all related to circumcision" (to paraphrase, when attempting to integrate material discussing the circumcision of females here) and "circumcision-related" (when referring to the certain editors' patterns of editing, attempting to suggest Tendentious editing or single purpose accounts on their part).
• (b) the Milos source cited doesn't immediately appear to place male circumcision in the context of sexual discrimination, and I'd rather not attribute something to a source even if another source can most likely be found confirming it.

Like anyone, I have automatic and immediate associations I feel make sense in the context of the article. I sometimes fail to discern whether having this generally-imposed rule some enforce on the article organization is the "current consensus" or whatever. The article is organized in such a way that my point of view on what the word "circumcision" means, which is clearly not unique judging by sources defining the word, and the reliable sources using the word, is completely excluded; again, a fact revealed not by the content of the article, but in its current organization and scope, when correlated with the views of reliable sources. The quality of discussion on its discussion page also perhaps suggests an WP:NPOV problem -- if a good number of reasonable editors on both sides of an issue can't agree that the content is neutral, is seems to suggest our treatment of it may be inappropriate. That said, I'll step back and say it could be much worse. As a whole it at least presents the pro-circumcision side fairly and succinctly, which was far from being the case before prolific and well written editors such as Jakew came along. Blackworm (talk) 22:30, 16 July 2009 (UTC)

"dishonest portrayal"

I suggest removing the phrase "dishonest portrayal" that was recently added to the article (or possibly changing the sentence around it somehow). The cited source says "Parents who watched their newborns being circumcised were horrified and considered themselves deceived by the dishonest portrayal of a surgery they had been led to believe was minor, necessary, and minimally painful " It doesn't say that there was any dishonest portrayal. It doesn't say that opponents of circumcision claimed there was any dishonest portrayal. It doesn't say that anyone claimed or argued that there was dishonest portrayal. It only says that parents considered that there was dishonest portrayal. So I don't think the source supports the current wording, which says "Opponents of circumcision argue, for example, that it ... is performed in part due to ... and sometimes providers' dishonest portrayals, ..." ☺Coppertwig (talk) 11:53, 19 July 2009 (UTC)

You write, "It doesn't say that anyone claimed or argued that there was dishonest portrayal. It only says that parents considered that there was dishonest portrayal." That is a contradiction, unless you don't consider parents to be "anyone." These parents are clearly also "opponents of circumcision" (now), thus making the sentence factual, sourced and referenced. Regardless, I don't care to get into one more argument with those questioning all my edits, so I've edited the article to remove the sourced, factual claim that parents who are opponents of circumcision believe that they chose the procedure because of dishonest portrayals. Blackworm (talk) 01:08, 21 July 2009 (UTC)

I agree that the parents are people. It's not clear to me that the parents mentioned are necessarily opponents of circumcision; if they are that's OR, and calling them "opponents of circumcision" in the article could give a misleading impression that they are activists. We can't tell from the article what the situation is. Maybe someone asked them whether there was dishonest portrayal, and they answered yes. That would indicate their internal feelings and beliefs; but it would not necessarily indicate that those parents would actively argue or claim that there was dishonest portrayal; and even if they would, it's not clear that that would necessarily make them opponents of circumcision: they could still (conceivably) consider it something that may be done but with more information given to parents and more anesthetic. Anyway, thank you for changing those words. ☺Coppertwig (talk) 15:32, 21 July 2009 (UTC)

That's conjecture, Coppertwig. The source states, "Parents who watched their newborns being circumcised were horrified and considered themselves deceived by the dishonest portrayal..." You state, "...it would not necessarily indicate that those parents would actively argue or claim that there was dishonest portrayal..." Yeah, okay, Coppertwig. I don't see how that follows. Blackworm (talk) 22:26, 21 July 2009 (UTC)

Modern procedures

We currently describe the Gomco , platibell and Mogen. These are all used for infants are they not? What about the methods used for adults? In the 3 randomised control trials in Africa they didn't use any of these methods. According to the Cochrane review: ANRS (the Auvert South African trial) used the forceps guided method. Bailey 2007 (kenya) used "Surgical Krieger forceps-guided method". Gray 2007 (Uganda) used “sleeve procedure”.

There is also no mention of laser circumcision which seems to be popular in the east in places such as Indonesia(often with disastrous results: http://www.themorningstarr.co.uk/2009/07/14/boys-penis-cut-off-with-laser/ ) Tremello22 (talk) 13:44, 21 July 2009 (UTC)

I haven't looked for sources, but from memory the Gomco is occasionally used in adult circumcisions. Similarly, the TaraKlamp (as well as similar disposable clamps) is sometimes used, particularly in developing countries. Use of clamps seems to be fairly rare in adults, however; forceps-guided or freehand techniques seem to be more common (at least that's my impression).

What changes are you actually proposing? Jakew (talk) 15:02, 21 July 2009 (UTC)

Re earlier reports

Please use accurate edit summaries; e.g. say "etc." at the end if your summary doesn't describe everything you did. Here some material was deleted, I believe, although the edit summary doesn't say so and it's hard to see in the edit since material was also moved. I think the material about "earlier" studies (re HIV) was deleted. At the moment I have no comment as to whether it should or shouldn't be deleted; I'm just noting this here in case I (at a later time) or others want to consider it. ☺Coppertwig (talk) 20:35, 24 July 2009 (UTC)

(ec) A recent edit to the HIV section has made a number of changes that require discussion.

A non-exhaustive list of the changes:

• According to the edit summary, "moved observational studies". It is unclear from the diff what was moved and why.
• Addition of "A recent mathematical model found that scaling up male circumcision would have a considerably lower impact than condom use or antiretorviral therapy (ART) coverage on new HIV infection rates and on death rates in men in South Africa", citing Lima, V. The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. 5th IAS Conference on HIV Treatment, Pathogenesis and Prevention. Cape Town. {{cite conference}}: Cite has empty unknown parameter: |booktitle= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help). There seems to be some confusion here - the title in the citation is that of the IAS abstract, but the link is to an AIDSMap article. The abstract is preferable. More importantly, if this is mentioned then other modelling studies should also be mentioned. I'll search for the references.
• Addition of "A randomised controlled trial in Uganda found that male circumcision did not reduce male to female transmission of HIV. The authors say they could not rule out the possibility of higher risk of transmission with men who do not wait for the wound to fully heal.", citing Wawer et al. "Say" should be past tense, preferably "stated".
• Addition of four sources to the sentence "Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy." Come on, we only site three sources when giving the mainstream view ("As a result of these findings, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent (parents consent for their infant boys)"). To cite twice that number when giving the view of a small minority is undue weight. Two is acceptable, three is borderline, six absurd. Jakew (talk) 20:38, 24 July 2009 (UTC)

I'll go through your points in turn Jake.

• You know what was moved because I moved them to circumcision and HIV. It is fairly obvious to anyone who has circumcision and HIV on their watch list.
• Fine. If you can find a model which contrasts the different approaches to HIV prevention I'd be happy for them to be included.
• I have no objection to using the abstract as opposed to the article.
• I don't see anything wrong with say . But I have no qualms about the changing of a minor word.
• Regarding weight. I don't see a problem with the number of references. We do not mention their names like we do the WHO, UNAIDS or CDC so it is not as if we are giving them equal prominence. The section tends to focus on developing countries such as Africa and doesn't say anything about developed countries so there are NPOV issues there. I personally think that that is more of an issue. So in all I think you are making a fuss over nothing as usual. Tremello22 (talk) 20:52, 24 July 2009 (UTC)

Ah, it wasn't obvious from the edit summary that you meant moving to another article, rather than moving within the section.

Regarding "say", there are two problems. First, the previous sentence uses "found", and it doesn't make sense to use the past tense in one sentence and the present tense in another. For consistency, "said" would be preferred. But technically, "said" is not strictly appropriate for written communication. Hence why I suggest "stated". Actually, thinking about it, a few other changes are needed: "The authors say they could not rule out the possibility of higher risk of transmission with from men who do did not wait for the wound to fully heal before engaging in intercourse."

Finally, as noted, the number of references is disproportionate. If there were nothing to make a fuss about then I assure you I would not make a fuss. Do you think any of the newly-added references are better quality than the original two? If so, we can cite those instead. Otherwise, I'm going to revert the additions. Jakew (talk) 20:59, 24 July 2009 (UTC)

Regarding say I have no problem with your improvement.

Regarding the additional references. Sorry but you haven't exactly explained why it is disproportionate. A few reasons why I think you are wrong. 1)The views of the WHO, CDC and UNAIDS are based on the 3 randomised control trials. Discussion of the trials already takes up most of the section. 2)The additional refs are not taking up any additional space. Each are interesting and have different things to say. 3)The views of the WHO, CDC and UNAIDS take up much more space so it is not undue weight at all. 4) We don't name the sources like we do the WHO, UNAIDS, and CDC. 5) We don't quote them like we do the WHO, UNAIDS and CDC.

So i am perplexed as to why you are so eager to revert a perfectly good edit to the article. You have also conveniently ignored what I wrote about the section being focused on developing countries like Africa and lacking info on circumcision's effect in developed countries. Tremello22 (talk) 21:17, 24 July 2009 (UTC)

Regarding "say", that's okay, then.

Regarding the additional references, I'm sure I've already explained this. To use three refs to discuss a mainstream point of view and then to use twice that number to discuss a minority point of view is out of proportion. To address your comments in turn: 1) The views of the six sets of authors are not exactly formed in a vacuum either. They reference the RCTs and observational studies, too. 2) Yes, they do take up additional space. The fact that it's in the references section rather than the body of the article does not mean that it is nonexistent. Also, all sources are potentially interesting and have different things to say; that's not by itself a compelling reason to tolerate undue weight. 3) Your argument here makes no sense: the views of the CDC, etc, ought to take up more space than those of a minority. 4) and 5) seem not to make sense.

So I'm not going to revert the entire edit, but I will partially revert it, to correct the undue weight problem. I'll also link to the abstract, and will adjust the "say" sentence. Jakew (talk) 21:29, 24 July 2009 (UTC)

Re disproportion: I think the idea is that we could probably find large numbers of refs giving a similar POV to the WHO etc., and we don't list all those, so per WP:UNDUE we shouldn't just list all refs we can find to support an opposing POV. I think usually in this article we don't list all possible refs but just state main points and give a small number of refs to support those points. Again, more detail can be given in the subarticles.

I don't have time to look at all the articles on my watchlist, and I appreciate informative edit summaries. Also, rather than simply putting an edit like this straight into the article, please first post a description of it on this talk page (similar to the description of your edit which Jake gave above) and wait for discussion, as requested by the template at the top of this talk page which says "Please discuss substantial changes here before making them". Also, when moving material from one page to another, to ensure GFDL compliance please follow the instructions at WP:SPLITTING; I corrected this with this edit. I would appreciate it if someone would quote on this talk page exactly what is the material that was deleted from this page (i.e. moved to the other page); it's hard to tell from the diff because material was apparently also moved from one part of this page to another in the same edit. I'm sorry if this seems like too many little rules, but a little effort by one person can make things easier for several other editors. ☺Coppertwig (talk) 00:58, 25 July 2009 (UTC)

I agree with Coppertwig's points above. I'd also add, re disproportion, that citing multiple refs can create the impression that there is more support for an idea than is actually present. To use an extreme example (deliberately extreme for purpose of illustration), consider the following sentence: "Some people think the earth is a sphere, whereas others think it is flat." Assuming you knew nothing about planetary geometry, and had to guess which was the mainstream view, and which was that of a minority, how would you guess? Jakew (talk) 08:42, 25 July 2009 (UTC)

As mentioned above, other modelling studies should be included if Lima et al is included. As promised, I've performed a search for refs. The initial results include the following:

• Orroth KK, Freeman EE, Bakker R; et al. (2007). "Understanding the differences between contrasting HIV epidemics in east and west Africa: results from a simulation model of the Four Cities Study". Sex Transm Infect. 83 Suppl 1: i5–16. doi:10.1136/sti.2006.023531. PMID 17405781. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Nagelkerke NJ, Moses S, de Vlas SJ, Bailey RC (2007). "Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa". BMC Infect. Dis. 7: 16. doi:10.1186/1471-2334-7-16. PMC 1832203. PMID 17355625.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
• Gray RH, Li X, Kigozi G; et al. (2007). "The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai, Uganda". AIDS. 21 (7): 845–50. doi:10.1097/QAD.0b013e3280187544. PMID 17415039. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Podder CN, Sharomi O, Gumel AB, Moses S (2007). "To cut or not to cut: a modeling approach for assessing the role of male circumcision in HIV control". Bull. Math. Biol. 69 (8): 2447–66. doi:10.1007/s11538-007-9226-9. PMID 17557187. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Londish GJ, Murray JM (2008). "Significant reduction in HIV prevalence according to male circumcision intervention in sub-Saharan Africa". Int J Epidemiol. 37 (6): 1246–53. doi:10.1093/ije/dyn038. PMID 18316348. {{cite journal}}: Unknown parameter |month= ignored (help)
• Hallett TB, Singh K, Smith JA, White RG, Abu-Raddad LJ, Garnett GP (2008). "Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa". PLoS ONE. 3 (5): e2212. doi:10.1371/journal.pone.0002212. PMC 2387228. PMID 18493593.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
• Auvert B, Marseille E, Korenromp EL; et al. (2008). "Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in Sub-Saharan Africa". PLoS ONE. 3 (8): e2679. doi:10.1371/journal.pone.0002679. PMC 2475667. PMID 18682725. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
• Boily MC, Desai K, Masse B, Gumel A (2008). "Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections: from efficacy to effectiveness to population-level impact". Sex Transm Infect. 84 Suppl 2: ii28–34. doi:10.1136/sti.2008.030346. PMID 18799489. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Jakew (talk) 08:35, 25 July 2009 (UTC)

Re:disproportionality , Jake asks "how would you guess which was the mainstream view?". I think you should give the reader a bit more credit. The reader can see from what is written that major organisations are advocating it.

three refs to discuss a mainstream point of view and then to use twice that number to discuss a minority point of view is out of proportion. We do not actually discuss what was said in these critical review studies, I think that is the point I was making.

the views of the CDC, etc, ought to take up more space than those of a minority And they still do with the added references.

Yes, they do take up additional space. The fact that it's in the references section rather than the body of the article does not mean that it is nonexistent I never said it was nonexistant. I said because they are simply references they only take up the space of 2 characters each as they are represented by numbers.

all sources are potentially interesting and have different things to say; that's not by itself a compelling reason to tolerate undue weight. I also said they had different things to say. As far as I know the WHO, CDC and UNAIDS are all saying the same thing. That is the main point which you have conveniently ignored.

4) and 5) seem not to make sense. What I was saying here was that the names of the authors of the critical studies are not mentioned. We also do not discuss what the criticisms actually were; with the WHO, CDC and UNAIDS, we actually discuss what they said.

Very few of the mathematical models you mention fit the criteria of contrasting MC with other methods of HIV prevention. Also, some aren't using the data from the RCT's. The mathematical model I included provides additional information to the reader. A mathematical model that says less people will be infected with HIV is obvious to anyone who has just read that MC reduces HIV infection by up to 60%, so is just taking up space. Tremello22 (talk) 21:18, 25 July 2009 (UTC)

Regarding my question re guessing the mainstream view, I'd be grateful if you'd actually answer my question. The example I chose did not name any organisations at all. I think it one would have to conclude that, in that example, the viewpoint that the earth is flat is given more weight. I agree that naming organisations can help to reduce this undue weight, but I don't think that excuses poorly chosen references (including the number of references used to support each point). Regarding your next point, I also agree that we don't discuss the content of these critical articles; again this may lessen the effect of undue weight, but it does not eliminate it. Moving on, when you say "they are simply references they only take up the space of 2 characters each" you seem to ignore my point that additional space is taken up in the references section - you're only counting space in the body text. Next, I don't think it's correct to say that the WHO, CDC, etc all say the same thing. They certainly have similarities (and we summarise an important similarity in the sentence describing their collective views), but they also have differences. Similarly, the critical articles have similarities (they're all critical of the RCTs and/or conclusions or decisions based upon them), but have differences too.

Regarding mathematical modelling studies, I wasn't aware that we had actually established the criteria that you describe. Nevertheless, I think that the findings of Hallett et al. and Podder et al. seem largely comparable to Lima et al., and others may be useful as well. Jakew (talk) 21:49, 25 July 2009 (UTC)

Okay, here's an initial draft of a paragraph describing modelling studies. This only includes Lima, Podder, and Hallett:

• Modelling of the population-level impact of circumcision has shown mixed results. Podder et al. reported that circumcision would reduce, but not eliminate HIV, stating that reduction was more effective when circumcision was combined with anti-retroviral drugs than with condoms. Disease elimination was considered feasible when all interventions were combined. Hallet et al. predicted "dramatic" reductions in HIV if circumcision were scaled up alongside behaviour change programmes. Lima et al., however, predicted that circumcision would have a "limited" impact in reducing HIV (3-13% reduction in HIV cases and 2-4% reduction in deaths); its impact would be "overshadowed when combined with the other interventions".

1. Podder CN, Sharomi O, Gumel AB, Moses S (2007). "To cut or not to cut: a modeling approach for assessing the role of male circumcision in HIV control". Bull. Math. Biol. 69 (8): 2447–66. doi:10.1007/s11538-007-9226-9. PMID 17557187. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
2. Hallett TB, Singh K, Smith JA, White RG, Abu-Raddad LJ, Garnett GP (2008). "Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa". PLoS ONE. 3 (5): e2212. doi:10.1371/journal.pone.0002212. PMC 2387228. PMID 18493593.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
3. Lima, V. The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. 5th IAS Conference on HIV Treatment, Pathogenesis and Prevention. Cape Town. {{cite conference}}: Cite has empty unknown parameter: |booktitle= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Jakew (talk) 09:35, 26 July 2009 (UTC)

We are discussing 2 separate issues here. I'd appreciate if we could concentrate on one thing at a time. So let us 1st discuss the amount of critical reviews that we can agree on and what impression we are trying to create.

Regarding my question re guessing the mainstream view, I'd be grateful if you'd actually answer my question. The example I chose did not name any organisations at all. I think it one would have to conclude that, in that example, the viewpoint that the earth is flat is given more weight Your use of this extreme analogy is a red herring. That is why I did not answer your question. Please stick on topic. Your example did not name organisations but the HIV section does. And people can see that 3 major organisations are advocating it. People can also see what the results of the trials were - that HIV was reduced by up to 60% through circumcision.

Why are the references poorly chosen?

Regarding your next point, I also agree that we don't discuss the content of these critical articles; again this may lessen the effect of undue weight, but it does not eliminate it. You haven't actually given a good reason why there is undue weight. Here you are saying that it does lessen the effect of undue weight but how are you calculating it is undue? If it is undue how are you calculating the extent to which it is undue?

Regarding space. I thought your argument was that more space means that the reader gets the impression that the anti-circ POV is more valid than it is in reality. The reader can only see the body text. So I don't see how a few extra small numbers creates a POV imbalance that justifies the fuss you are making.

I don't think it's correct to say that the WHO, CDC, etc all say the same thing. They are advocating it. So what we have is a whole paragraph focusing on the positive results of these trials. Then we have these major organisations saying "on the basis of these results we advocate it... (or words to that effect).

One thing that may be causing the problem here is that the section heading, 'Medical aspects' restricts and determines the criteria for inclusion. I wonder if that is deliberate on your part? We seem to focus too much on the studies themselves and therefore restrict critical commentaries or the social implications of these studies. I mean, say if we wanted to discuss Africa in general and its attitude to circumcision, there doesn't seem to be a place for that. We tell the reader of these studies that circumcision reduces HIV but we don't mention anything about where circumcision is going to be used to prevent HIV. Nor do we mention where circumcision fits in with other HIV prevention strategies. Tremello22 (talk) 19:49, 26 July 2009 (UTC)

As I acknowledged, it is an extreme example, but I'd still be grateful if you'd answer my question. It is an important question, I believe, because it gets to the fundamental issue of whether the number of references cited in support of a point can influence the reader.

Regarding "poorly chosen references", I thought the parenthetical comment immediately after that phrase explained it: "(including the number of references used to support each point)"

As I've said above, devoting twice the number of references to a minority point of view than to a mainstream point of view is disproportionate, ie., undue weight. I don't understand why further explanation is required.

Regarding the amount of space, I don't understand your argument that the "reader can only see the body text". I've just viewed the page twice, once as a logged-in reader, and once as an IP user, and both times the references were visible. Do you find different results? I should also say that this has nothing to do with the validity of a POV, which we do not even try to judge, but instead with it's prominence.

I don't quite understand the relevance of your assertion that the WHO, CDC, etc "are advocating it". Jakew (talk) 20:15, 26 July 2009 (UTC)

It seems I am not getting through to you, so maybe we should get an outside view on things. What do you say? Tremello22 (talk) 20:18, 26 July 2009 (UTC)

Jakew? Tremello22 (talk) 20:56, 26 July 2009 (UTC)

Tremello: re discussing the social implications: perhaps you could put on this talk page some suggested text, and if we agree that adding it would be due weight, then we can discuss where it would go, changing section headings if necessary. ☺Coppertwig (talk) 20:59, 27 July 2009 (UTC)

RFC

The topic is circumcision for HIV prevention. One wikipedian thinks the addition of more critical references will create a NPOV problem ; another member thinks it will enhance the article. See above discussion for more info. Tremello22 (talk) 21:08, 26 July 2009 (UTC)

Given that the request concerns the representation of viewpoints in the scientific literature, I think we might get more feedback if we changed the RFC from {{rfc.tag|soc}} (Society, sports, law, and sex) to {{rfc.tag|sci}} (Maths, science, and technology). (Note: I've added "."s to try to avoid confusing the rfc bot. 14:01, 27 July 2009 (UTC)) I'm not certain, but I presume that it can be simply changed, and the bot will update as needed. If nobody objects, I'll make the change. Jakew (talk) 07:52, 27 July 2009 (UTC)

Why don't we manually list it at both? -- Avi (talk) 07:55, 27 July 2009 (UTC)

• Note, this is listing incorrectly at the moment and so I have deleted the template above to avoid confusion (I came from the RFC monitoring page). I apologise if you had this under control already. If you follow the guidance of the RFC template, the tag should look like ((rfctag | soc | sci)) followed immediately by the question. I suggest you make this a new sub-section and re-write the question.—Ash (talk) 14:18, 27 July 2009 (UTC)

A sample of the literature

The following represents the first two pages of results found when performing a search for 'circumcision hiv' using the PubMed search engine. The search was conducted today, within about an hour of this post. Although this is non-random (PubMed usually lists results in rough reverse chronological order), it should be reasonably non-biased, and probably less biased than any selection by a less systematic method would be. Two pages is a fairly small number of articles; if anyone wishes to add to the table that would be appreciated.

Note: the purpose of this sample was to identify and classify views specifically regarding circumcision and HIV. Consequently, the "classification" column indicates whether the viewpoint expressed was positive that circumcision reduced the risk of HIV or not. Thus in this context, "positive" does not indicate that circumcision is a good thing generally; it has a more specific meaning than that. I've included the rationale for each classification. In some cases definite classification was judged to be impossible from the data available; in these cases I have left it as unclassified.

• See table at /Sample PubMed

Note, table moved for readability in accordance with wp:RTP.—Ash (talk) 17:07, 27 July 2009 (UTC)

(I'm inserting this here because it is expected that it will be useful to those responding to the Request for Comment, which suggests that readers 'see above'.) Jakew (talk) 16:42, 27 July 2009 (UTC)

Another sample of the literature

(ec) The issue here is whether listing 6 references to support a minority viewpoint gives too much weight to that viewpoint when only four references are listed for the mainstream viewpoint. A related issue is whether 6 consecutive superscripts unduly clutter the article and slow page loading time. (I believe page loading time is heavily influenced by the number of ref tags.) The edit in question is here, listing 6 refs after the words "Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy".

As an attempt to determine what amount of weight to put on the two viewpoints (supporting or challenging the results of the randomized controlled trials), I'm doing a Google Scholar search for "circumcision HIV prevention randomized" from 2007 to 2009. I'm marking results as "supportive" if they seem to support the idea that there is evidence that circumcision reduces HIV, and "challenging" if I feel that they support the wording Tremello had added to the article with 6 refs. In this analysis, therefore, I'm marking results as "supportive" if they agree that there is evidence of protective effect but raise other concerns about taking action in response to such evidence. An analysis of the first 20 of 1400 hits:

• First two hits are two randomized controlled trials (RCTs) in 2007.
• 3rd hit is irrelevant (trial of diaphragm and lubricant gel)
• 4th hit: (supportive); a modelling study concluding "Large-scale uptake of male circumcision services in African countries with high HIV prevalence, and where male circumcision is not now routinely practised, could lead to substantial reductions in HIV transmission and prevalence over time among both men and women." (Nagelkerke et al 2007 )
• 5th hit: (supportive) Weiss et al 2008, "Male circumcision for HIV prevention: from evidence to action?" says "Responding to the conclusive evidence that male circumcision offers significant protection for men from HIV infection, several countries..."
• 6th hit: (not accessed) Male circumcision to cut HIV risk in the general population. The Lancet, Volume 369, Issue 9562, Pages 617-619 M. Newell, T. Bärnighausen 2009. I can't access the full text or abstract at the moment so I can't assess it.
• 7th hit: (supportive) Sullivan et al 2007 "It is now clear that male circumcision can be efficacious for men in reducing their risk of HIV acquisition through sex with women"
• 8th hit: (irrelevant perhaps) Westercamp et al 2007 . Perhaps not directly relevant; seems to be about how people feel about being circumcised, but seems to me to assume that the evidence is supportive.
• 9th hit: Kigosi et al 2007 Again not directly relevant.
• 10th hit: (not accessed) Male circumcision and HIV/AIDS: challenges and opportunities. The Lancet, Volume 369, Issue 9562, Pages 708-713 S. Sawires, S. Dworkin, A. Fiamma, D. Peacock, G. Szekeres, T. Coates. I can't access the abstract or full text at the moment so I can't assess it.
• 11th hit: (challenging) Potts et al "The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain." Science 9 May 2008: Vol. 320. no. 5877, pp. 749 - 750 DOI: 10.1126/science.1153843
• 12th hit: (challenging?) "However, the protection of MC may be partially offset by increased HIV risk behavior, or “risk compensation,” especially reduction in condom use or increases in numbers of sex partners." Kalichman S, Eaton L, Pinkerton S (2007) Circumcision for HIV Prevention: Failure to Fully Account for Behavioral Risk Compensation. PLoS Med 4(3): e138. doi:10.1371/journal.pmed.0040138
• 13th hit: (supportive) "Male circumcision could have substantial impact on the HIV epidemic and provide a cost-effective prevention strategy if benefits are not countered by behavioral disinhibition." AIDS: 23 April 2007 - Volume 21 - Issue 7 - p 845-850 doi: 10.1097/QAD.0b013e3280187544
• 14th hit: (supportive) assumes that "Male circumcision reduces the risk of HIV acquisition by approximately 60%" but raises concerns about safety.
• 15th hit: (supportive) Rennie et al Journal of Medical Ethics 2007;33:357-361; doi:10.1136/jme.2006.019901 Copyright © 2007 by the BMJ Publishing Group Ltd & Institute of Medical Ethics.
• 16th hit: (not accessed) Gray and Wawer Randomised trials of HIV prevention The Lancet, Volume 370, Issue 9583, Pages 200-201 R. Gray, M. Wawer I can't access the full text or abstract at the moment so I can't asses it.
• 17th hit: (supportive) Journal of Sexual Medicine Volume 4 Issue 4i, Pages 838 - 843 Published Online: 10 Jul 2007 Vardi et al. Acknowledges evidence for HIV prevention but says more evidence is needed about health risks and benefits.
• 18th hit: (challenging?) Millet et al. JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 December 2007 - Volume 46 - Issue 5 - pp 643-650 doi: 10.1097/QAI.0b013e31815b834d Study fails to find evidence that African results apply in the United States, but would have expected to see such results if the African results applied directly. However, it also states that the RCTs "found that circumcision conferred a strong protective effect", so it's apparently not directly challenging the results, only whether the results apply in the US.
• 19th hit: (irrelevant) "Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial"
• 20th hit: (supportive) Weiss, 2007 Current Opinion in Infectious Diseases: February 2007 - Volume 20 - Issue 1 - p 66-72 doi: 10.1097/QCO.0b013e328011ab73 (incidentally: mentions keratin in the abstract: this increases the notability of the keratin explanation, of which I had already argued for mention in the article).

In this analysis I count 8 articles (marked "supportive") which appear to me to agree that the RCTs are evidence that circumcision can have a protective effect against HIV, and two (marked "challenging?") which could perhaps be considered as challenging those results or their implications in some way but which I don't think go so far as to support the words Tremello inserted into the article, and one marked "challenging" which I have classified as challenging the validity of the results although I have only accessed a one-sentence summary.

This analysis suggests to me that the supportive interpretation of the results of the RCTs should be given considerably more weight in the article than opposing views, and that possibly the words Tremello added might not represent a sufficiently notable viewpoint for inclusion in this article but that a more nuanced opposing POV should probably be included (e.g. maybe not claiming that the results are not valid, but raising concerns about safety, other effects, whether there is sufficient reason at this time to take action, whether it applies in the US etc.) I also looked at a few of the references Tremello gave to support that point, and I think "challenge the validity" may not be an accurate representation for at least some of them, or may need to be made clearer as to what is being challenged (the results? the trials themselves in some sense? the conclusions of the authors of the trials?): For example, the ref by Garenne says "The trial was certainly well conducted, and it nicely confirmed observational studies, which came to the same conclusion . However, a number of their concluding statements deserve a comment."

I agree with Jakew that the reader can see the superscripts and the references section and that putting a larger number of references can give the reader an impression of weight, so we shouldn't put too many references for minority POVs in this summary article; more detailed info can go in the subarticles. Given the selection of refs for the mainstream viewpoint, listing 6 refs for the challenging viewpoint is way too many in my opinion. (involved editor) ☺Coppertwig (talk) 17:37, 27 July 2009 (UTC)

Which is the minority POV? I have done a quick review of the first recent articles I could access via Scholar:

• (supports thesis) Male circumcision reduced HIV incidence in men without behavioural disinhibition. Circumcision can be recommended for HIV prevention in men.

• (supports thesis) Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa. Where appropriate, voluntary, safe, and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible.

• (supports thesis) Infections were 60% fewer in the treatment group, which seems to indicate that circumcised men are much less likely to become infected with HIV when having sex with infected women. In communities where HIV is common, circumcision may prove to be a valuable tool for reducing men's risk of getting infected. However, as with most studies, criticisms could be made of some aspects of the methods used, and more research is needed before we can be sure. We must also remember that circumcised men can still become infected, even though the risk might be lower. They should still take other steps to prevent themselves from getting HIV.

• (no conclusion) No clear conclusion made - notes results look positive, but cannot be certain until mortality rates can be established.

• (no conclusion) Modelling based on assumed outcomes of trials - discusses difficulties of circumcision programs.

• (no conclusion) Discusses cost benefits of such programs

• (no conclusions) Rveiews the 13 papers on issue, highlights the popularity of the practice in Africa, and details the limitations in existing studies as well as discusses the potential of poorly trained practitioners.

• (refutes the thesis) Research did not find correlation in different population (not sub-Saharan Africa).

• (no conclusions) Accepts the thesis, and looks at implications for treatment for people not part of the research group (e.g. MSM).

• (no conclusions) Reviews research, which it acknowledges supports the thesis, but needing more evidence to extrapolate to other societies.

The papers about research on heterosexuals in sub-Saharan Africa support the thesis. The sole paper on a different cultural setting refutes the thesis. The rest review the findings, find some problems with sampling/methodology, and most suggest that the findings support the practice for heterosexual males in sub-Saharan Africa, but that more research would be needed in other cultures and amongst different populations (e.g. homosexual males) and that the findings cannot be generalised. One UK paper suggests that for males coming to the UK from sub-Saharan Africa, the procedure would be supported, but not for indigenous gay males.

To report these findings as anything other than locational would be undue - and most of the reports that have not had corresponding results are from populations not covered by the research. The way evidence works, the refutation of a thesis should carry more weight than its denial - that is basic scientific method. You cannot exclude research on the basis that there is less refutation than correlation, as it is the refutation shows the thesis is flawed. Once the thesis is re-stated in a more specific form, then it can be tested more widely, and so on. All that can be said at present is that there appears to be a benefit for heterosexual males in sub-Saharan Africa. Not that circumcision generally has any benefit. So, the POV being expressed relates to a minority of the global population. Mish (talk) 18:41, 27 July 2009 (UTC)

Thanks for your input, Mish. Could you please clarify a couple of things: What is the "thesis" you're referring to? What is the difference between "refutation" and "denial", or did you accidentally say "denial" when you meant something else? (I interacted with Mish a couple of days ago while I was responding to an RfC on another page.) Thanks again, ☺Coppertwig (talk) 18:52, 27 July 2009 (UTC)

Apology - I was rushing due to other things I need(ed) to attend to. I meant to post this under the RfC. The 'thesis' is that male circumcision is an effective preventative measure against HIV infection (it is a thesis, as circumcision is a novel surgical procedure in this context - using genital surgery as a means of treating/preventing infection). The research cited is in sub-Saharan Africa. When somebody puts forward a thesis, other researchers test the hypothesis, to see whether the results are confirmed, if they don't, this refutes the thesis. I think I may have used denial when I meant refutation - as I edited what I had started to write to make it more in line with how theories are proved/disproved. Perhaps it would be helpful, rather than presenting positions as views, in that way. The research shows that the hypothesis appears to hold in one context, but not in others, and those who review the research acknowledge that while this new form of treatment may be beneficial in that context, there is no evidence that this can be generalised. Mish (talk) 20:05, 27 July 2009 (UTC)

Most studies have assessed more specific questions than that, such as "is circumcision effective in reducing the risk of female-to-male transmission of HIV". The events that led to this RfC involved the statement that "Some have challenged the validity of the African randomized controlled trials , prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy". In any event, I'm very uncomfortable about trying to decide which viewpoint is correct — I don't think that's our role as Wikipedians; all we can do is to report on viewpoints in proportion to their prominence. Jakew (talk) 20:36, 27 July 2009 (UTC)

Right. We're not testing which is correct, but how much prominence they have. The refs such as WHO don't state (as far as I was able to find) that circumcision is effective in sub-Saharan Africa; they simply state that it is effective. So I'm not sure to what extent we can justify qualifying such statements here. We might be able to state in a separate sentence that others have pointed out that it may not apply to the US or whatever, or we may be able to imply context: at least one of the refs stated in a separate paragraph that the report was focussed on sub-Saharan Africa. ☺Coppertwig (talk) 20:43, 27 July 2009 (UTC)

Yes, reviewers either discuss the relevance for those outside the sample - homosexual males, people outside sub-Saharan Africa, women - and whether the sampling/methodology is adequate (especially as the research was not completed) - and how research in other situations has not produced the same findings. Because this is all discussed in relevant reviews, and released after the sub-Saharan reports, it is pertinent. If you are looking for prominence, neither the original papers nor those that refute the findings are the most prominent, but reviews which acknowledge the significance of the findings, but point to the difficulties in extrapolating the findings beyond the context - so this has to be given as much weight as the sub-Saharan research. The refutation should be acknowledged, but not accorded as much weight as these, as there have been fewer papers that have reported contrary findings - but they are significant. This has nothing to do with whether the research is correct, but about the weight the different perspectives should be given. If anything, reviews and publication by WHO should receive more weight than the original papers, as these are effectively secondary sources, which guidelines suggest are preferable to primary sources (such as the original papers). Mish (talk) 23:11, 27 July 2009 (UTC)

I agree that reviews, policy statements, and meta-analyses are secondary sources and hence ought to receive the most weight. I can't speak for Coppertwig, but the purpose behind my sample of the literature was to try to ascertain, in a reasonably unbiased manner, the prevalence of various viewpoints in the literature. The results show, as do Coppertwig's, that those who " the validity of the African randomized controlled trials " are in a small minority. I did not limit my results to reviews or meta-analyses; having done so (using PubMed's 'limits' tab), the first page of results contained:

• 14 articles which were positive with respect to a protective effect against F->M HIV transmission: PMID 19393910, PMID 19370585, PMID 19327028, PMID 19132004, PMID 19033753, PMID 19027631, PMID 18800244, PMID 18705758, PMID 18687456, PMID 18684670, PMID 18649445, PMID 18558320, PMID 18466727, PMID 18382737
• 1 which was about female genital cutting, hence may be excluded: PMID 19065392
• 1 which was exclusively about MSM (hence not F->M), hence may be excluded: PMID 18840841
• 1 which was apparently negative, though perhaps not to the extent of challenging validity of RCTs: PMID 18824614
• 3 which were impossible to classify from the abstract (if present): PMID 18568868, PMID 18366947, PMID 18330032

For clarity, I should note that I'm saying that these articles are positive, but not necessarily gung ho. Many do list caveats. Many do advocate some degree of caution. But the more extreme viewpoint that circumcision is not protective against F->M HIV transmission, that the RCTs were invalid, etc., seems to be that of a small minority at best. Jakew (talk) 09:23, 28 July 2009 (UTC)

Right! So we may be asking the wrong question. Instead of how much weight to put on each of two opposing viewpoints, we can ask how to represent the various nuances expressed by the articles, and try to avoid giving the impression that an unqualified positive viewpoint has any more weight (if any) than justified by the RS. ☺Coppertwig (talk) 21:52, 28 July 2009 (UTC)

That seems a good suggestion Coppertwig. Maybe we should create a draft to try out ideas and see if we can satisfy everyone: Talk:Circumcision/HIVsectiondraft. Maybe we can also agree on the purpose of the section. Is it to just list studies or is it to discuss the social implications of the studies? Mish has talked a bit about this above. Tremello22 (talk) 18:53, 29 July 2009 (UTC)

Confusion over versions of RfC

I suggest that in future, when we do RfCs, we discuss and agree on the wording of the question before the RfC starts. ☺Coppertwig (talk) 18:32, 27 July 2009 (UTC)

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Regarding circumcision for HIV prevention, what is the appropriate balance of critical and supportive references to balance WP:NPOV and WP:UNDUE? Please see above for details. -- Avi (talk) 14:47, 27 July 2009 (UTC)

Tremello's original RfC question was "The topic is circumcision for HIV prevention. One wikipedian thinks the addition of more critical references will create a NPOV problem ; another member thinks it won't cause a POV problem but will enhance the article. See above discussion for more info". Inserted after Mish had replied below) ☺Coppertwig (talk) 18:26, 27 July 2009 (UTC)

From looking through what is on the article, it appears that there is no firm conclusion either way, so you ought to represent this, citing whatever sources are necessary, and mentioning any notable organisations in relation to their position(s) on the debate. You also need to draw a clearer distinction between individual benefits and epidemiological benefits in relation to the populations affected.

For example, what benefits there are (if any) of circumcision in the following situations:

• HIV- circumcised man who penetrates HIV+ woman
• HIV- uncircumcised man who penetrate HIV+ woman

• HIV- woman penetrated by circumcised HIV+ man
• HIV- woman penetrated by uncircumcised HIV+ man

• HIV- circumcised man who penetrate HIV+ man
• HIV- uncircumcised man who penetrate HIV+ man
• HIV- man penetrated by circumcised HIV+ man
• HIV- man penetrated by uncircumcised HIV+ man

And how that is seen as translating to epidemiology and the social benefits beyond individual protection (if any). That is what I would be interested in, as a reader. Mish (talk) 16:36, 27 July 2009 (UTC)

Clarification on the addition of 4 references

It seems there was (still is?) confusion over what I see as a problem and the reason why I though the 4 references enhanced the article and didn't cause a POV problem. I have been discussing what the problem is on my talkpage with Avi and Coppertwig:User_talk:Tremello22#RfC_Statement. I'll continue the discussion here:

I was discussing with Avi POV balance in general. I asked Avi why he thought the addition of 4 critical studies created a problem.

Balancing sources and references so as not to unduly emphasize one side or the other outside of the existing penetration each has in the literature. -- Avi (talk) 19:25, 27 July 2009 (UTC)

Avi ,I go by common sense and the wikipedia guidelines.

PRO:

Over forty epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection. Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV.

Experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group. The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively. A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection. The authors also stated that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit. An updated Cochrane review concluded: "Inclusion of male circumcision into current HIV prevention measures guidelines is warranted, with further research required to assess the feasibility, desirability, and cost-effectiveness of implementing the procedure within local contexts."

As a result of these findings, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent. Both the WHO and CDC indicate that circumcision may not reduce HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with a female partner. The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention.

ANTI:

Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.

Does this make you see my point a bit better? Tremello22 (talk) 19:33, 27 July 2009 (UTC)

I think the point you're making is that there is much more text (therefore much more weight) given in the article to the position that circumcision can reduce the risk of HIV, than to the position that there is still (after the RCTs) not enough evidence to conclude that circumcision can reduce the risk of HIV.

However, in order to argue for a change to the article, you would need to argue that this difference in weight doesn't correspond to the relative weights in the sources. See the three literature searches (by Jake, me and Mish) at Talk:Circumcision#A sample of the literature and the subsection following it; I think they show that in the sources, there is much more weight given to the former than to the latter, so it's not at all clear to me that any change is needed. ☺Coppertwig (talk) 19:40, 27 July 2009 (UTC)

First, let me say that it is incorrect to place the following sentence in either the PRO or ANTI sections: "Over forty epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection. Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV.". That is an introduction. Second, WP:UNDUE requires weight and space in proportion with the penetration the positions have in the literature outside wikipedia, as I said above. The evidence being brought now indicates that the literature is not as balanced as I originally thought, and that proportionate weight should be given to the positions that are more supported by the literature, within bounds of balance. I've always said that I allow myself to be convinced by suitable and well-founded arguments. Jake and Coppertwig have brought evidence; by all means, please respond in kind. Another suggestion may be that perhaps you should post a "block" on the talk page of how you perceive a balanced section would be, and we can take it from there. -- Avi (talk) 20:02, 27 July 2009 (UTC)

Actually the introduction could be counted as procirc-biased because it doesn't say where they intended to use circ for HIV prevention. It is for places where the HIV rate is high; so primarily in Africa, not developed countries. Therefore it is wrong to assume that it was ever considered to use it in general, in all countries. It is subtle so I understand why you wouldn't spot it.

My basic point is that if people want to read the opposing view they have a choice of more than 2 studies to look at:

Studies included already:

• Cautious optimism for new HIV/AIDS prevention strategies. Siegfried 2006 Lancet - Comments on South African control trial saying it could over-estimate effect because trial stopped early.
• Male circumcision and HIV prevention: is there really enough of the right kind of evidence?, Dowsett 2007 RHM

Additional reviews:

• Neonatal circumcision does not reduce HIV/AIDS infection rates, Sidler 2008 S.AfMJ
• Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable, Myers 2009 S.AfMJ
• Male Circumcision and HIV Control in Africa, Garenne 2006 PLoS
• Male circumcision is not the vaccine we have been waiting for,Green 2008 FHIVT

These review studies discuss circumcision to prevent HIV in general as opposed to just criticising the RCT's. That was my main reason why I wanted all 6. The current HIV section creates the impression that circumcision is a worthwhile measure in combatting HIV in all countries. The question of whether circumcision is a good measure in tackling HIV in all countries is the question you should be searching pubmed and Google Scholar for, not just whether the 3 African RCT's are valid. If we are calculating the correct POV balance on this question (is circumcision is a good measure in tackling HIV in all countries) then it would be more 50/50, rather than balanced in favour of circumcision.

After my edit little has changed:

Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.

It doesn't create an incorrect POV at all. What has happened is that in little space we have provided a lot more info for the reader to peruse if he/she so wishes. Tremello22 (talk) 21:05, 27 July 2009 (UTC)

I'm under the general impression that there is a fairly prominent viewpoint in RS that the results from Africa can't necessarily be assumed to apply in other countries. However, at the moment I don't know where to find any refs that state that, except one: the 18th hit (Millet et al) in my list above, but I think it's just a primary source. Can you find any, Tremello? ☺Coppertwig (talk) 21:22, 27 July 2009 (UTC)

The CDC say in their "Considerations for the United States" section that there are certain differences between African and US settings. The main problem they outline, however, is not that the protective effect wouldn't exist, but that the absolute risk (and hence absolute risk reduction) is so much lower in the US that the risk:benefit balance is considerably different. It's important to remember that there are two questions: whether it has a protective effect (which is a purely scientific question), and whether it should be done (sub-questions of this being 'where should it be done' and 'among whom').

On another point, none of the "additional reviews" Tremello22 identifies are actually reviews. Sidler is labelled as "OPINION". Myers is labelled as "EDITORIAL". Garenne is labelled as "Correspondence". And Green is identified as an "EDITORIAL" (as an aside, there was a fascinating response to Green et al. here). This isn't by itself an argument for or against (though in general we should prefer reviews over opinion pieces, and meta-analyses/systematic reviews over plain reviews), but accuracy is important. Jakew (talk) 09:45, 28 July 2009 (UTC)

What is the status of this discussion?

It seems to me nobody is adressing the question. We have had one outsider come in and recognise problems with the section . I expected that because I feel the same way and I trust my opinion. It seems to me that discussion has turned to major changes (or even a re-write?) to the section as opposed to just tagging on 4 additional references. I would have been happy with the additional references giving the opposing point of view. Maybe we can keep the additional references and someone can come up with a better sentence leading up to the references? Tremello22 (talk) 19:32, 28 July 2009 (UTC)

Do you understand the reasons that have been given why putting in those additional references would give undue weight to a minority POV? ☺Coppertwig (talk) 01:17, 29 July 2009 (UTC)

Summing up this discussion

Coppertwig, I'll answer your question and try to sum everything and list where I think the difficulties have arisen. I'll start a new section so everyone doesn't get lost.

Do you understand the reasons that have been given why putting in those additional references would give undue weight to a minority POV? ☺Coppertwig (talk) 01:17, 29 July 2009 (UTC)

How we assign weight (i.e. text, and to a lesser extent superscript refs) is dependent on what the purpose of the section is.

A)Is it to just report the results of the RCT's? By this I mean figures.

B)Is it to list what major organisations say as a result of these trials?

C)Is it to i) mention the flaws some commentators found ii) Discuss whether the flaws effected the results.

D)Is it to talk about circumcision's role in combating HIV in Africa?

E)Is it to talk about the effect circumcision has on lowering HIV levels in places with low HIV prevalence (i.e developed countries - such as the USA or the UK)?

F)Is it to talk about how HIV compares with other prevention strategies? This would be dependent on place of course.

There are probably other questions too. Namely, should we talk about the progress in scaling up circumcision? How it is going etc.

So that is why I don't think doing a search at pubmed or google scholar answered anything. In order to progress we need to answer the above questions first.

Let me say, I already knew that more people agreed with the conclusions of the RCT's, that circumcision lowers HIV. That is why major organisations such as the WHO,CDC etc adopted that position. They wouldn't have done so otherwise. After most observational studies showing a protective effect (albeit with confounding factors) 3 experiments showing a protective effect is proof enough for the scientific community that it does reduce it. What is done with this knowledge, there is more disagreement on that.

The argument here was specifically over whether the addition of 4 more references created an incorrect POV balance based on the literature ( as said above, whether the balance is correct is dependent on the purpose of the section - maybe people didn't take that into account?). It was not about how much of a minority view is the view that the RCT's were invalid/whether circ reduces female to male transmission of HIV; I am not arguing over that.

I separated the sections into PRO and ANTI above and I think that demonstrated that given that I feel that the section has more than one role , it clearly doesn't create an incorrect POV balance if we are assuming the section is trying to answer the questions I listed above (C,D,E,F). Why? Because the POV balance on those questions (C,D,E,F) is not weighted in favour of circumcision as much as it is with A and B. Maybe the disagreement is simply over the anti-circ sentence (Some have questioned the validity...)? If people are serious about discussing any of this then Talk:Circumcision/HIVsectiondraft is probably the best place to start. Alternatively we can take the hassle free route and add the 4 additional references as an easy way of giving an approximate balance (PRO vs. ANTI) on all the issues (not just the simple question of whether circ reduces females to male transmission) Tremello22 (talk) 19:55, 29 July 2009 (UTC)

Tremello, please bear in mind that references do not exist in isolation, but are closely linked to the text. Increasing the weight of a given sentence can only be justified if the viewpoint expressed in that particular sentence has a corresponding weight in the literature. Thus, for example, the sentence "some argue that the earth is flat" should have a weight roughly proportional to the prevalence of that viewpoint in reliable sources. It would be inappropriate to base it on the degree to which it is believed that the flatness or sphericality of the earth is relevant for interplanetary travel.

In this particular case, they would follow the sentence: "Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy." This sentence has nothing to do with your points D, E, F, so it makes no sense to use any perceived imbalance in terms of those to justify it. Instead, the sentence is primarily about point C, but this brings us back to where we started because — as noted above — the viewpoint that the RCTs are flawed/invalid is that of a distinct minority.

The primary purpose of the section is to answer the question, "what is the relationship between circumcision and HIV". Everything else is secondary to that question, and must be because if there were no relationship then other questions would be moot. There are several important sub-questions, involving M->F transmission, F->M transmission, and M->M transmission. And there are secondary questions, too: how is this affecting prevention policies, etc. But the weight given to the viewpoint of those who dispute the very existence of the relationship (by claiming that the evidence is invalid or that circumcision is ineffective) must reflect the prominence of that viewpoint. Jakew (talk) 21:24, 29 July 2009 (UTC)

Promotion links

I don't understand the reasoning behind this edit. MaleCircumcision.org is a website operated by "WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the AIDS Vaccine Advocacy Coalition (AVAC), and Family Health International (FHI)". It seems far more credible, and indeed more encyclopaedic, than circlist.com, which is probably one of our least suitable external links. Jakew (talk) 19:27, 27 July 2009 (UTC)

I was trying to respond to the imbalance of references, as explained on User_talk:Jesse1066#Reference addition to Circumcision. If I over-reverted, my apologies, and please correct the issue. By all means, if there is a better source that can replace a weaker one there, that should be discussed here and then implemented. I do not have a specific allegiance to one over the other. -- Avi (talk) 19:34, 27 July 2009 (UTC)

Jesse1066 has re-added malecircumcision.org, so the question is, do we revert the addition, or do we remove circlist.com again (essentially reverting a little further)? I'm unhappy with disturbing the numerical balance of links, so would prefer not to leave the addition for too long. Jakew (talk) 19:48, 27 July 2009 (UTC)

I deleted circlist.org. I think Avi just made a mistake, that's all. I had been thinking of doing that edit myself anyway, but you got there first. The link added by Jesse1066 looks good. ☺Coppertwig (talk) 20:00, 27 July 2009 (UTC)

Unfortunately, I make all too many; thanks for cleaning it up, Coppertwig. -- Avi (talk) 20:05, 27 July 2009 (UTC)

No problem: it's a wiki!!! ☺Coppertwig (talk) 20:11, 27 July 2009 (UTC)

Great! I'll tidy up the entry to put it in a similar style to the other links. Jakew (talk) 20:15, 27 July 2009 (UTC)

Thanks! ☺Coppertwig (talk) 21:24, 27 July 2009 (UTC)

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